Acland's Video Atlas of Human Anatomy | Cervical and thoracic vertebrae TRANSCRIPT (5.01) Now that we’ve looked at one vertebra, let’s look at the specialized and different features of vertebrae from the cervical, thoracic, and lumbar parts of the spine. Here’s a typical cervical vertebra, the fourth one. The body is small. The upper surface of the body is curved, somewhat in the shape of a saddle. The lower surface has the same curvature in reverse. The vertebral foramen is large and triangular. The neural arch is formed mainly by the two straight laminae. The pedicles are very short. The spinous process is short, and ends in a double point. The upper articular facets face upward and inward, the lower ones face downward and forward. The mass of bone between the articular facets is called the articular pillar. The transverse processes arise from the side of the body, and also from here on the articular pillar. The transverse process of a cervical vertebra has a hole in it, the transverse foramen, through which the vertebral artery passes. The transverse process is shaped like a gutter, pointing downwards.

It ends in two tubercles, an anterior, and a posterior, where the scalene muscles attach. Of the seven cervical vertebrae, the first two, which are called the atlas and the axis, differ from the others in several ways. We’ll see them in detail in Volume 4 of this Atlas. The seventh cervical vertebra also differs from the others, in that it has a long spinous process ending in a single point, which forms this small prominence on the back of the neck. The cervical vertebrae form the most mobile part of the spine, partly because of the curved shape of their bodies, which makes flexion and extension easy and partly because of the shallow slope of their articular processes, which makes lateral flexion easy. The ... [Read More] (5.01) Now that we’ve looked at one vertebra, let’s look at the specialized and different features of vertebrae from the cervical, thoracic, and lumbar parts of the spine. Here’s a typical cervical vertebra, the fourth one. The body is small. The upper surface of the body is curved, somewhat in the shape of a saddle. The lower surface has the same curvature in reverse.

The vertebral foramen is large and triangular. The neural arch is formed mainly by the two straight laminae. The pedicles are very short. The spinous process is short, and ends in a double point. The upper articular facets face upward and inward, the lower ones face downward and forward. The mass of bone between the articular facets is called the articular pillar. The transverse processes arise from the side of the body, and also from here on the articular pillar. The transverse process of a cervical vertebra has a hole in it, the transverse foramen, through which the vertebral artery passes. The transverse process is shaped like a gutter, pointing downwards. It ends in two tubercles, an anterior, and a posterior, where the scalene muscles attach. Of the seven cervical vertebrae, the first two, which are called the atlas and the axis, differ from the others in several ways. We’ll see them in detail in Volume 4 of this Atlas. The seventh cervical vertebra also differs from the others, in that it has a long spinous process ending in a single point, which forms this small prominence on the back of the neck.

The cervical vertebrae form the most mobile part of the spine, partly because of the curved shape of their bodies, which makes flexion and extension easy and partly because of the shallow slope of their articular processes, which makes lateral flexion easy. The movements that can occur in the cervical spine are forward flexion, extension, and lateral flexion, to one side or the other. Rotation also occurs in the neck. Almost all of it happens at the specialized joints between the atlas and the axis vertebrae, which we’ll look at in the tape on the head and neck,Volume 4 of this atlas. In that tape we’ll also look at the way the atlas vertebra articulates with the bone which forms the underside of the skull, the occipital bone. The joints between the atlas and the occipital bone are called the atlanto-occipital joints. Next we’ll look at the special features of the thoracic vertebrae. The bodies of the thoracic vetebrae become progessively more massive from above down, as they do from the top to the bottom of the vertebral column. Each of the thoracic vertebrae articulates with a pair of ribs.

On each side, the vertebra articulates with the rib at two points: here at the end of the transverse process, and here, where the pedicle meets the body. We’ll be looking at the ribs in the second section of this tape. The transverse processes of the thoracic vertebrae point sideways, the spinous processes points downwards, each one overlapping the one below. The articular processes are almost vertical: the upper ones face almost straight backwards, the lower ones face forwards. There’s only a little movement between thoracic vertebrae, partly because of the presence of the ribs, and partly because of the way the spinous processes are arranged. The movements that are possible are small amounts of forward flexion, lateral flexion, and perhaps surprisingly, rotation. [Read Less] The Spine About Watch and Favorite Watch Watching this resources will notify you when proposed changes or new versions are created so you can keep track of improvements that have been made. Favorite Favoriting this resource allows you to save it in the “My Resources” tab of your account. There, you can easily access this resource later when you’re ready to customize it or assign it to your students.

The Spine The spine encases the spinal cord for protection and support. Learning Objective Describe the vertebral column, the protective structure of the spinal cord Key Points The human spine consists of 24 articulating vertebrae grouped into cervical, thoracic, and lumbar regions. Nine more vertebrae make up the sacrum and coccyx. Typical vertebrae consist of the anterior vertebral body and the posterior section, which contains the vertebral foramen through which the spinal cord passes. There are four main curves of the spine: cervical, thoracic, lumbar, and pelvic. Facets of the vertebrae restrict range of movement to prevent shearing of the spinal cord. Blood vessels and nerves exit the spinal column at intervertebral foramina . There are four main curves of the spine: cervical, thoracic, lumbar and pelvic. Terms The series of vertebrae that protect the spinal cord; the spinal column.

Examples Kyphosis is an exaggerated concave (kyphotic) curvature of the thoracic vertebral column ; it is commonly known as "humpback." Lordosis is an exaggerated convex (lordotic) curvature of the lumbar region; it is commonly known as "swayback." Scoliosis is an abnormal lateral curvature of the vertebral column. Full Text Number of Vertebrae In human anatomy , the vertebral column (backbone or spine) usually consists of 24 articulating vertebrae and nine fused vertebrae in the sacrum and the coccyx. Situated in the dorsal aspect of the torso and separated by intervertebral discs , it houses and protects the spinal cord in its spinal canal. There are normally 33 vertebrae in humans, including the five that are fused to form the sacrum, the four coccygeal bones that form the tailbone, and the others separated by intervertebral discs. The upper three regions comprise the remaining 24, and are grouped as cervical (seven vertebrae), thoracic (12 vertebrae) and lumbar (five vertebrae).

This diagram of the vertebral column delineates the sacral curve, cervical curve, thoracic curve, lumbar curve, coccygeal vertebrae, sacrum, lumbar vertebrae, thoracic vertebrae, cervical vertebrae. Vertebral Shape A typical vertebra consists of the vertebral body and vertebral arch . These parts together enclose the vertebral foramen that contains the spinal cord. The vertebral arch is formed by a pair of pedicles and a pair of laminae . Two transverse processes and one spinous process are posterior to (behind) the vertebral body. The spinous process projects toward the posterior direction, while one transverse process projects to the left and the other to the right. The spinous processes of the cervical and lumbar regions can be felt through the skin. Facet joints are located above and below each vertebra. These restrict the range of movement. Between each pair of vertebrae are two small openings called intervertebral foramina through which the spinal nerves exit.

This oblique view of a cervical vertebra delineates the spinal cord, spinal nerve, nucleus pulpus, disc annulus, superior articular process, spinous process, posterior tubercle of transverse process, foramen transversium, anterior tubercle of transverse process, vertebral body. Vertebral Curvature When viewed laterally, the vertebral column presents several curves corresponding to the different regions of the column: cervical, thoracic, lumbar, and pelvic. Cervical and Thoracic Curves The cervical curve convexes forward and begins at the apex of the odontoid (tooth-like) process. It ends at the middle of the second thoracic vertebra . The thoracic curve convexes dorsally, begins at the middle of the second thoracic vertebra, and ends at the middle of the 12th thoracic vertebra. Lumbar Curve The lumbar curve, which is more pronounced in women than in men, begins at the middle of the last thoracic vertebra and ends at the sacrovertebral angle. It is convex anteriorly with the lower three vertebrae much more convex than the upper two. This curve is described as a lordotic curve.

The pelvic curve begins at the sacrovertebral articulation and ends at the point of the coccyx; its concavity is directed downward and forward. Primary and Secondary Curves The thoracic and sacral curvatures are termed primary curves because they are present in the fetus and remain the same in the adult. As the child grows, lifts the head, and begins to assume an upright position, the secondary curves (cervical and lumbar) develop. The cervical curve forms when the infant is able to hold up his or her head (at three or four months) and sit upright (at nine months). The lumbar curve forms between twelve to eighteen months when the child begins to walk. Cervical and Thoracic Spine - Your neck and midback anatomy Cervical and Thoracic Spine Print Cervical Spine This is your neck, which contains seven vertebrae(C1–C7). The last, C7 is the bone that generally sticks out the most. You can easily feel it at the base of your neck, especially when you bend your head forward. Go ahead, see if you can find it. The cervical vertebrae's main job is to support your head.

This is no small feat given that the head can weigh as much as 11 pounds! That's why how you hold your head matters so much. For many computer workers, a small but constant forward jut of the head is not uncommon. The result can transmit forces deep into the neck and shoulders. Stress to your neck muscles can lead to joint misalignment, which can pinch nerves. The result? Ouch! A sore neck with pain possibly radiating down into your arms. Think about how many directions you can move your head. There's up, down, side to side, forward and back, and around. It can tilt like a bobble head. Thank the cervical vertebrae—in particular, the pivoting action of C1—for all those marvelous movements. And that's a good thing most of the time. On the downside, the highly flexible neck makes it especially vulnerable to injury—such as whiplash when your head is thrust forward due to impact from a rear-end auto crash. Thoracic Spine This is your rib-cage/midback area and it has 12 vertebrae (T1–T12). Unlike your other vertebrae, these attach to your ribs.

The thoracic spine can move forward relatively easily, though it's much more limited bending backward. This part of your back is not typically a huge problem when it comes to back pain(most problems occur in the lower back). The midback can, however, be overly curved in some individuals, a condition called kyphosis. It often results from bad posture—think of slouching teenagers. But it can also be caused by disease. Either way, the excessive curve makes a person appear hunchbacked. There can be some discomfort with kyphosis caused by disease, but postural kyphosis doesn't generally cause much pain. However, excessively rounding your thoracic spine may also lead to the head being positioned forward, which, as we mentioned earlier, causes problems in your neck. The forward slumping also shortens the muscles in front of your torso and overstretches some back muscles. This can lead to discomfort when you try to sit up straight. The good news is that you can correct this with good posture and proper exercise. Jason Highsmith, MD is a practicing neurosurgeon in Charleston, NC and the author of The Complete Idiot's Guide to Back Pain. Click here for more information about the book .

Updated on: 02/09/16 Spinal Anatomy Spinal anatomy Somatic Nervous System The spinal anatomy is engaged in almost every movement made by the human body. Our arms, legs, chest and head all are attached to the spine . The spine’s complex arrangement of bone, cartilage, ligaments, nerves, muscles, blood vessels and other tissue is strong enough to support the body, yet flexible enough to allow for a wide range of motion. All in all, our spinal anatomy is the foundation for all physical function, including exercise, sitting, walking and resting. Sections of the spinal anatomy The term spinal anatomy can also refer to the more common term backbone, and not without reason: there are 33 bones in the spine, known as vertebrae , which are stacked from top to bottom. These vertebrae are categorized into five areas.

The categories are: Cervical spine (C1 to C7) — this is the upper or neck area of the spine, which is made up of the seven vertebrae at the top of the spine, which help support the head Thoracic spine (T1 to T12) — the 12 vertebrae in the central section, to which the ribs are attached Lumbar spine (L1 to L5) — the five vertebrae toward the lower back, which support much of the body’s weight Sacrum (S1 to S5) — the five fused vertebrae located between the pelvic bones Coccyx (tailbone) — the four fused vertebrae at the base of the spine Function of the spinal anatomy In addition to structural support, the vertebral column provides protection for the spinal cord, a very important of the spinal anatomy. The spinal cord runs from the brain, along the spine through the spinal canal , and ends between the L1 and L2 vertebrae. The spinal cord is part of the central nervous system and is the primary pathway for messages from the brain to the rest of the body.

Nerve roots branch off the spinal cord and exit the spinal column through openings in the vertebrae called foramina. Spine conditions within the spinal anatomy can lead to neck or back pain caused by compressed or irritated nerve roots. These conditions include herniated or bulging discs, spinal arthritis and bone spurs, as well as other degenerative conditions. If you are dealing with a spine condition that is causing nerve compression, contact Laser Spine Institute to learn about the advantages of our minimally invasive spine surgery over traditional open neck or open back surgery. We can review your MRI report or CT scan and determine if you are a possible candidate for one of our minimally invasive spine surgery. Want to chat? Association Between Cervical and Thoracic Somatic Dysfunction Among Second-Year Osteopathic Medical Students | The Journal of the American Osteopathic Association Association Between Cervical and Thoracic Somatic Dysfunction Among Second-Year Osteopathic Medical Students Joseph P. Brindise, DO ; Kenneth E. Nelson, DO ; Robert E.

Kappler, DO Author Notes From Botsford Hospital in Farmington Hills, Michigan (Dr Brindise), and the Department of Osteopathic Manipulative Medicine at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois (Drs Nelson and Kappler) Address correspondence to Joseph P. Brindise, DO, Botsford Hospital, Office of Medical Education, 28050 Grand River Ave, Farmington Hills, MI 48336-5919. E-mail: jbrindise@botsford.org Author Contributions Dr Kappler provided substantial contributions to conception; Drs Nelson and Brindise provided substantial contributions to design, acquisition of data, or analysis and interpretation of data; Dr Brindise drafted the article or revised it critically for important intellectual content; and Drs Kappler, Nelson, and Brindise gave final approval of the version of the article to be published. Association Between Cervical and Thoracic Somatic Dysfunction Among Second-Year Osteopathic Medical Students The Journal of the American Osteopathic Association, July 2014, Vol. 114, 540-548.

doi:10.7556/jaoa.2014.107 The Journal of the American Osteopathic Association, July 2014, Vol. 114, 540-548. doi:10.7556/jaoa.2014.107 Get Citation Citation Brindise JP, Nelson KE, Kappler RE. Association Between Cervical and Thoracic Somatic Dysfunction Among Second-Year Osteopathic Medical Students. J Am Osteopath Assoc 2014;114(7):540-548. doi: 10.7556/jaoa.2014.107. Download citation file: You are adding an alert for: Association Between Cervical and Thoracic Somatic Dysfunction Among Second-Year Osteopathic Medical Students You will receive an email whenever this article is corrected, updated, or cited in the literature.

You can manage this and all other alerts in My Account The alert will be sent to: Sign In or Subscribe × Abstract Context: The ubiquitous nature of cervical and thoracic somatic dysfunction requires osteopathic physicians to have a strong working knowledge of regional spinal mechanics and their functional and dysfunctional interrelationships. Objective: To determine whether cervical and thoracic somatic dysfunction occur concomitantly, particularly somatic dysfunction of the occipitoatlantal (OA) and upper thoracic (T1-T4) region of the spine. Methods: A retrospective analysis of cervical and thoracic somatic dysfunction prevalence diagnosed by faculty in second-year osteopathic medical students was conducted. Somatic dysfunction was defined as a vertebral unit possessing any of the following palpatory characteristics: tissue texture changes, asymmetry of motion and relative position, restriction of motion, or tenderness (ie, TART criteria). For each instance of somatic dysfunction diagnosed, the segmental level identifying the superior segment of the involved vertebral unit was recorded, as well as the spinal region (ie, cervical [OA, atlantoaxial (AA), and C2-C7] or thoracic [T1-T12]).

Descriptive analyses, a Pearson χ2 test, and a regression model using an analysis of variance were performed on the data. Results: Among 338 students included in the study, the following 5 vertebral segments were found to have the highest prevalence of somatic dysfunction: OA (257 [76.0%]), C3 (257 [76.0%]), T3 (247 [73.1%]), T5 (226 [66.9%]), and T4 (223 [66.0%]). A Pearson χ2 test of association between the OA vertebral segment and the following segments were found to be statistically significant: AA (P=.024), C2 (P=.032), and T4 (P=.045).

An analysis of variance revealed statistical significance between the prevalence of upper cervical (OA, AA, C2) somatic dysfunction and the prevalence of upper thoracic (P<.001) and midthoracic (T5-T8) (P<.001) somatic dysfunction; the prevalence of lower cervical (C3-C7) (P=.74) and lower thoracic (T9-T12) (P=.085) somatic dysfunction was not found to be significant. Conclusion: A statistically significant association between cervical somatic dysfunction and thoracic somatic dysfunction was confirmed. In addition, there was a statistically significant association between dysfunction of the OA and the AA, C2, and T4 vertebral segments. These results suggest that the number of dysfunctional vertebral segments in the upper thoracic and midthoracic spinal regions is directly proportional to the number of dysfunctional segments found in the upper cervical spinal region. The tenets of osteopathic medicine state that the human body is a unit and that structure and function are reciprocally interrelated. 1 In other words, mechanical stresses, injury, or asymmetry affecting one part of the body can create compensatory mechanical changes affecting seemingly unrelated other parts of the body.

By applying these concepts, osteopathic physicians are able to effectively provide patients with distinct osteopathic treatment that enhances functional status and maintains or restores health. Somatic dysfunction is defined as “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic and neural elements.” 2 Studies have found that somatic dysfunction of the cervical and thoracic regions of the spine is frequently encountered in clinical practice. For example, Slezynski and Glonek 3 reported that somatic dysfunction was most prevalent in the cervical region, followed by the thoracic (ie, T1 to T4) region. In addition, Licciardone et al 4 reported that somatic dysfunction was most commonly diagnosed in the upper thoracic, midthoracic, and cervical regions. The ubiquitous nature of cervical and thoracic somatic dysfunction requires osteopathic physicians to have a strong working knowledge of regional spinal mechanics and their functional and dysfunctional interrelationships. Many clinicians and researchers have described and helped define the mechanisms linking cervical somatic dysfunction with thoracic somatic dysfunction.

Johnston and colleagues 5 - 8 were some of the first individuals to describe how cervical and thoracic somatic dysfunctions were interrelated and associated with hypertension. They suggested that this relationship is neurophysiologic and influences both the somatic and cardiovascular systems. Payan 9 and de Groat 10 recognized that nociceptive input from the cervical spinal region produces palpable musculoskeletal changes in the upper thoracic spinal region and ribs, as well as increases sympathetic output from this area. Similarly, Heinking and Kappler 11 reported that substantial suboccipital tissue texture abnormality is usually associated with changes in the ipsilateral upper thoracic and rib angle area, and Richards 12 stated that cervical somatic dysfunction is rarely found without related somatic dysfunction in the upper thoracic area. Richards also stated that T2 to T4 somatic dysfunctions are common, as the sympathetic nerves to the head and neck originate in the upper thoracic region. Others have described cervical and thoracic postural abnormalities as being related through neurologic reflexes. 13 - 15 A predominantly muscular, ligamentous, or bony linkage between the cervical and thoracic regions has also been described.

Thoracic, shoulder, and low back segmental somatic dysfunction and pain have been identified as potential causative or complicating factors in patients with chronic mechanical neck disorders and pain. 16 - 19 Additionally, thoracic somatic dysfunction has been described as an important predictor of neck and shoulder pain. 16 , 20 Larson 21 described how the mechanics of the cervical and upper thoracic spinal regions are linked through the attachments of the longus colli muscle. According to Hruby, 22 cervical and upper thoracic motions are associated with the interdependent combination of asymmetric vertebral and upper rib shapes and attachments, and their interactions with muscles are responsible for cervical extension and side-bending. The goal of the present study was to evaluate the association between occipitoatlantal (OA) somatic dysfunction and upper thoracic somatic dysfunction. Although the relationship between the cervical and thoracic spinal regions has been previously demonstrated in clinical studies, the present study is the first to our knowledge to examine the specific relationship between somatic dysfunction of the OA and upper thoracic vertebral segments. We hypothesized that there would be a statistically significant association between OA somatic dysfunction and upper thoracic somatic dysfunction.

Methods We retrospectively reviewed data on the prevalence of diagnosed cervical and thoracic somatic dysfunction in second-year osteopathic medical students at the Midwestern University/Chicago College of Osteopathic Medicine (MWU/CCOM) in Downers Grove, Illinois. The data reviewed and analyzed were collected from skills testing examinations that took place during academic years 2008-2009 and 2009-2010. The protocol for the present study was reviewed and approved by the Midwestern University Institutional Review Board. The board determined the study to be exempt from requiring informed consent. The prevalence data were collected from skills testing examinations that are required to be successfully completed at the end of the second academic year by all osteopathic medical students before they commence predoctoral clinical training. All MWU/CCOM second-year osteopathic medical students who participated in the examinations during the study period were included in the study. No participating students were excluded from the study. To maintain student confidentiality, all of the students' names and identifying information were removed from the written examination records. Each written examination record was then characterized and identified by a numerical code.

For the examination, vertebral segments in the cervical and thoracic spinal regions of each student were screened for somatic dysfunction. Somatic dysfunction was defined as a vertebral unit possessing any of the following palpatory characteristics: tissue texture changes, asymmetry of motion and relative position, restriction of motion, or tenderness (ie, TART criteria). 2 For each instance of somatic dysfunction diagnosed, the segmental level identifying the superior segment of the involved vertebral unit was recorded, as well as the spinal region (ie, cervical or thoracic). Ten members of the teaching faculty, including licensed osteopathic physicians and osteopathic manipulative medicine teaching fellows, from the MWU/CCOM Osteopathic Manipulative Medicine Department performed the diagnostic examinations. No consensus training occurred. Data collected from the written examinations were transferred to a Microsoft Excel spreadsheet for management and then to SPSS statistical software (version 18.0; SPSS Inc) for analysis. P values less than .05 were considered statistically significant. Descriptive analyses, a Pearson χ2 test, and a regression model using an analysis of variance were performed. Descriptive statistics were compiled for the prevalence of somatic dysfunction at a given spinal level or in a given spinal region.

The Pearson χ2 test was used to examine associations between OA somatic dysfunction and segmental cervical or thoracic somatic dysfunction. An analysis of variance was used to examine the prevalence of somatic dysfunction for given spinal regions, specifically the upper cervical (OA, AA [atlantoaxial], C2) and the upper thoracic (T1-T4), midthoracic (T5-T8), and lower thoracic (T9-T12) regions of the spine. Results A total of 338 MWU/CCOM second-year osteopathic medical students were included in the study. Of the 6760 vertebral segments examined, 3329 (49.2%) were found to have diagnosed somatic dysfunction: 1452 (43.6%) in the cervical spinal region and 1877 (56.4%) in the thoracic spinal region ( Table 1 ). Table 1. Abbreviations: AA, atlantoaxial; NA, not applicable; OA, occipitoatlantal.

× Comment The present study found that the prevalence of somatic dysfunction was highest in the cervical, upper thoracic, and midthoracic regions of the spine. There was a lower prevalence of somatic dysfunction diagnosed in the lower thoracic region. These findings are consistent with previous epidemiologic studies of somatic dysfunction prevalence. 3 , 4 The understanding that somatic dysfunction in the OA region is associated with somatic dysfunction in the AA and the axial-third cervical vertebral units was previously described by Fryette. 23 Fryette stated that these 3 vertebral units—the OA, the AA, and the axis on the third cervical vertebra—lock and unlock as a unit on the basis of their bony topography and their capsular and ligamentous attachments. More recently, Rudolfsson et al 24 studied range of motion in the upper and lower cervical spinal regions of individuals with chronic neck pain and found that range of motion was more limited for the upper than for the lower cervical levels. They also suggested that a 3-segment model gives more information than a 2-segment model in characterizing range of motion impairments.

Authors of both studies 23 , 24 suggest the importance of considering the spine as a whole when dealing with upper cervical somatic dysfunction. Fryette 23 further stated the most common dysfunction of the occiput-atlas-axis articulations is likely to be a compensation for conditions lower in the spine because the head always tends to adjust itself to the line of gravity. These clinical observations and biomechanical assessments are in agreement with the findings that segmental OA somatic dysfunction has a statistically significant association with AA and axial-third cervical vertebra somatic dysfunction. Furthermore, it supports the notion that upper thoracic and midthoracic somatic dysfunction is directly associated with upper cervical somatic dysfunction. As previously stated, several authors have suggested that the linkage between cervical somatic dysfunction and thoracic somatic dysfunction is mediated by the sympathetic nervous system. 9 - 12 , 22 , 25 In the cervical sympathetic nervous system, the preganglionic autonomic fibers originate in the intermediolateral gray column of spinal cord segments T1 through T5. Additionally, nociceptive afferent fibers from the cervical region of the spine travel with the sympathetic nerves and synapse in the upper thoracic spinal cord.

Thus, nociceptive input from the cervical region of the spine reflexively produces palpable musculoskeletal changes in the upper thoracic region of the spine and the ribs. 12 , 13 Furthermore, sympathetic nerve supply to striated muscles alters muscle tone and contractile forces. 19 Kappler and Ramey 25 state that somatic dysfunction in the upper thoracic spinal region, cervicothoracic junction, and cranium can result in increased levels of sympathetic tone. These authors also note an association of the increased sympathetic tone with increased muscle tone, vasoconstriction, and facilitation of afferent pain signals. The facilitation, in concert with the reduction in blood supply to the muscles of the upper back, neck, and head, causes an increase in muscle tenderness and sensitivity to pain. Pain felt locally in the upper thoracic or midthoracic spinal region may originate either from the local thoracic joints or be referred from the cervical joints.

26 , 27 Arana et al 28 found that correlations of degenerative thoracic disk contour changes at the levels of C7 through T1, T1 through T2, T2 through T3, and T3 through T4 were statistically significant in patients with cervical pain. These anatomical relationships further substantiate the findings that OA somatic dysfunction correlates with upper thoracic somatic dysfunction. Myofascial continuity connects cervical somatic dysfunction with thoracic somatic dysfunction by means of muscular, ligamentous, and bony linkages. The concept of myofascial continuity is exemplified by the fact that muscular and ligamentous structures that attach to or span multiple joints exert their actions onto those joints and areas of the body. 29 Magoun 30 suggests that the fascial connections below and the 3 dozen or more muscles that attach to the cranial base can affect the occiput and thus alter its articular contacts. The coupling of cervical and upper thoracic spinal mechanics has been attributed to the longus colli muscle, as it attaches to the anterior surface of the vertebral column, between the atlas and the third thoracic vertebra.

21 , 31 It has been suggested that asymmetrical vertebral and upper rib shapes and attachments and their interaction with the cervical musculature can be responsible for the association between cervical and thoracic somatic dysfunction. Specifically, the splenius musculature has been identified as a responsible agent because the splenius capitis muscle attaches inferiorly to the upper 3 or 4 thoracic vertebrae, while the splenius cervicis muscle attaches inferiorly to the third through the sixth thoracic vertebrae. 22 , 31 The nuchal ligament may also connect cervical somatic dysfunction and thoracic somatic dysfunction because it extends from the external occipital protuberance to the spinous process of the seventh cervical vertebra. Additionally, the nuchal ligament is composed from the aponeuroses of the trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis muscles. 32 The primary limitation of the current study was the use of second-year osteopathic medical students as the study population. In our experience, medical students tend to be young, healthy, and generally asymptomatic.

For the current study's topic—cervical and thoracic somatic dysfunction—it would have been more advantageous to study ambulatory patients in the clinical setting with cervical or thoracic spine symptomatology. Another limitation of the current study was that the prevalence data were retrospectively collected from a formal assessment of osteopathic medical students' manipulative medicine skills. During this formal assessment, the teaching faculty were permitted to act autonomously and employ their unique diagnostic methods. Autonomous examiners can have poor interexaminer reliability. 33 To improve interexaminer reliability, future studies should either use a single examiner or include consensus training of examiners. 34 - 37 The present study's retrospective design prohibited the incorporation of consensus training into the protocol. Additionally, this study design precluded the ability to collect, analyze, and comment on the ipsilateral relationship of cervical and thoracic dysfunctional mechanics because of the recording format of the student examination. The goal of the current line of research is to better understand the functional relationships between the cervical and thoracic regions of the spine. The current study was designed to identify and statistically analyze the commonly described association between cervical and thoracic somatic dysfunction.

Future studies should consider a prospective design using both symptomatic and asymptomatic participants and investigate how osteopathic manipulative treatment directed at upper thoracic somatic dysfunction could concomitantly affect cervical somatic dysfunction. Conclusion The findings of the present study revealed statistically significant segmental associations between the cervical and thoracic spinal regions, specifically between the OA and the AA, C2, and T4 vertebral segments. The results also suggested that the number of dysfunctional segments found in the upper thoracic and midthoracic spinal regions is directly proportional to the number of dysfunctional segments found in the upper cervical spinal region. Acknowledgment We thank Kurt Heinking, DO, chairman of the Osteopathic Manipulative Medicine Department at MWU/CCOM, for his support. Financial Disclosures: None reported. References 1 Seffinger MA, King HH, Ward RCet al. Osteopathic philosophy. In: Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2011:3-22. 2 Glossary of osteopathic terminology. In: Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed.

Baltimore, MD: Lippincott Williams & Wilkins; 2011:1087-1110. 3 Slezynski SL, Glonek T. Outpatient osteopathic SOAP note form: preliminary results in osteopathic outcomes-based research. J Am Osteopath Assoc. 2005;105(4):181-205. . Accessed May 1, 2014. 4 Licciardone JC, Nelson KE, Glonek Tet al. Osteopathic manipulative treatment of somatic dysfunction among patients in the family practice clinic setting: a retrospective analysis. J Am Osteopath Assoc. 2005;105(12):537-544. . Accessed May 1, 2014. 5 Johnston WL, Hill JL. Spinal segmental dysfunction: incidence in cervicothoracic region. J Am Osteopath Assoc. 1981;81(1):22-28. [PubMed] 6 Johnston WL, Hill JL, Sealey JW, Sucher BM.

Palpatory findings in the cervicothoracic region: variations in normotensive and hypertensive subjects—a preliminary report. J Am Osteopath Assoc. 1980;79(5):300-308. [PubMed] 7 Johnston WL, Kelso AF, Babcock HB. Changes in presence of a segmental dysfunction pattern associated with hypertension, part 1: a short-term longitudinal study. J Am Osteopath Assoc. 1995;95(4):243-248,253-255. [PubMed] 8 Johnston WL, Kelso AF. Changes in presence of a segmental dysfunction pattern associated with hypertension, part 2: a long-term longitudinal study. J Am Osteopath Assoc. 1995;95(5):315-318. [PubMed] 9 Payan DG. Peripheral neuropeptides, inflammation, and nociception. In: Willard FW, Patterson MM, eds. Nociception and the Neuroendocrine-Immune Connection, Proceedings of the 1992 American Academy of Osteopathy International Symposium.

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General Characteristics of the Spine The spine is made of vertebrae that link together to protect the spinal cord. Learning Objective Describe the structure of the vertebral column Key Points The main functions of the vertebral bones are for structure ( posture ) and protection of the spinal cord . The spine is split into five regions: the cervical, thoracic, lumbar, sacral, and coccyx. The vertebrae of the sacrum and coccyx are fused, but those of the cervical, thoracic, and lumber regions are free to articulate. Viewed laterally, the vertebral column presents several curves that correspond to the column's different regions—the cervical, thoracic, lumbar, and sacral. Terms Register for FREE to remove ads and unlock more features! Learn more Full Text The vertebral column (also known as the backbone or spine), is a tall, thin organ located dorsally that extends from the base of the spine to the pelvis . It protects the spinal cord and provides a key attachment point for numerous muscle groups.

There are 33 vertebrae in the human spine that are split into four regions that correspond to the curvature of the spine; the cervical, thoracic, lumbar, sacrum, and coccyx. The vertebrae of the sacrum and coccyx are fused, but those of the cervical, thoracic and lumbar regions are separated by intervertebral discs . Vertebrae are given an alphanumeric descriptor, with the initial letter derived from the region they are located in followed by a digit; the digit increases moving down the region. For example, the most superior cervical vertebra is termed C1 and the most inferior C7, which is then followed by the T1 vertebrae of the thoracic region. This is a profile view of the spine with its four regions identified. These are called, from the top of the spine to its base, the cervical, thoracic, lumbar, and pelvic regions. Viewed laterally the vertebral column presents several curves that correspond to the different regions of the column. These are called the cervical, thoracic, lumbar, and pelvic regions. The cervical curve covers the region between vertebrae C1 and T2, it is the least marked of all the spinal curves.

The thoracic curve covers the region between vertebrae T2 and T12. The lumbar curve covers the region between vertebrae T12 and L5 and is more marked in the females than in males due to differences in pelvic structure. The sacral curve begins at the sacrovertebral articulation , and ends at the point of the coccyx. The thoracic and sacral curves are termed primary curves because they alone are present during fetal life . The cervical and lumbar curves are secondary curves that are developed after birth; the former when the child is able to maintain an upright posture, the latter when the child begins to walk. Cervical Spine Anatomy (Neck) - Vertebrae and Cervical Spinal Nerves Cervical Spine Anatomy (Neck) Print The cervical spine (sometimes abbreviated as c-spine in the medical world) begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6, and C7. The cervical nerves are also abbreviated; they are C1 through C8.

Cervical Vertebrae and Supporting Spinal Structures The cervical bones (the vertebrae) are smaller in size when compared to other spinal vertebrae (in your thoracic or lumbar spines). The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement (eg, rotate side to side, bend forward and backward). A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors. Spinal Cord and Cervical Nerve Roots Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the peripheral nervous system (PNS). The PNS is the complex system of nerves that branch off from the spinal nerve roots.

These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers—throughout the entire body. Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (eg, spinal cord injury or a spinal fracture). Pain, numbness, weakness, and tingling are symptoms that may develop when one or more cervical spinal nerves are injured, irritated, or stretched. Because the cervical nerves control many bodily functions and sensory activities, specific symptoms from a cervical spine injury vary depending on which nerves are affected. Below, the parts of the body controlled by cervical nerves are summarized. C1: Head and neck C4: Upper body muscles (eg, deltoids, biceps) C5: Wrist extensors

Question: In human anatomy, what can be cervical or thoracic, amongst others?
Answer: Vertebrae